NSAIDs

Question 1

Aspirin

Answer 1

• nonselective COX-1 and -2 inhibitor, only NSAID to inhibit both COX
• Valued primarily for anti-platelet aggregation effects
• Contraindication: avoid in children with Reye syndrome
• avoid in patients on blood thinners
• For all NSAIDs: abdominal pain, dysplasia, nausea, vomiting, ulcers

Question 2

Ibuprofen

Answer 2

• analgesic and antipyretic, antiinflammatory
• interferes with the antiplatelet effect of low dose aspirin, rendering aspirin less effective for MI and stroke prevention

Question 3

Neproxin

Answer 3

• Similar profile to other NSAIDs

Question 4

Celecoxib

Answer 4

• Cox-2 selective
• analgesic, antipyretic, anti-inflammatory
• no effect on platelet aggregation
• 10-20x more selective for cox-1 and -2
• used for RA

Question 5

Glucocorticoids

Answer 5

• Mech: prevents conversion of membrane phospholipids to arachidonic acid by inhibiting the phospholipase A2 enzyme
• Short-term GC: hydrocortisone, cortisone, prednisone
• Long-acting GC: Dexamethasone

Question 6

Prednisone

Answer 6

• active metabolite is prednisolone
• Mech: blocks phospholipase A2
• Use: asthma, RA, COPD

Question 7

Methotrexate

Answer 7

• 1st line non-Biologic DMARD for RA
• Mech: inhibits transformylase and thymidylate sythestase enzyme
• Use: RA and other arthritis
• Adverse effects: do not take with NSAIDS
• contraindicated in pregnancy

Question 8

Azathioprine

Answer 8

• Mech: works thru 6-thioguanine
• non-biological DMARD
• Use: approved for RA
• Adverse effects: bone marrow suppression

Question 9

Abatacept

Answer 9

• Mech: prevents activation of T-cells
• Use: RA
• Adverse effects: increased risk of lymphomas
• monthly cost of $3500-3800

Question 10

Adalimumab

Answer 10

• Mech: prevents ligand from binding to TNFa receptor
• monoclonal Types: infiximab, adalimumab, certolizumab, golimumab
• circulating receptor fusion protein: etenercept
• Use: RA